Crohn’s Disease – Therapeutic Options Beyond Medication

Dr. Larissa Niemeyer
About the Author

Larissa Niemeyer is a medical doctor and PhD candidate in the Department of Child and Adolescent Psychiatry at the Central Institute of Mental Health in Mannheim, Germany and her doctoral thesis focuses on reasons for non-adherent behavior in adolescents with psychiatric disorders.

Crohn’s disease is a chronic inflammatory condition affecting the gastrointestinal tract – causing injuries or wounds anywhere in between the mouth and anus. Symptoms usually start in young adults, but can also occur in children or later in life. Often, it takes quite some time until a doctor diagnoses it because of the wide variety of symptoms.

Patients suffering from Crohn’s disease often experience diarrhea, stomach pain, and unwanted weight loss. Furthermore, and these are all unspecific symptoms, they might report fever, fatigue, problems with their skin, joints or eyes. Symptoms come and go and might be severe at one point and relatively mild at another [1].

It is currently not completely understood what causes the disease. Data suggest a combination of genetic and environmental factors, like smoking, oral contraceptive, and antibiotic use. On the other hand, being exposed to pets and farm animals is believed to decrease the risk. Furthermore, a high fiber intake, fruit consumption, and physical activity have also been linked to a risk reduction [2,3].

Therapeutic options to treat Crohn’s disease are different types of medication, and treatment decisions are guided by the age of the patient, symptoms, and extent of the disease. Corticosteroids, immunomodulators, and biologics (these are monoclonal antibodies) are often used, sometimes also in combination [4].

Another possible treatment option is to provide nutrients that directly influence the intestines. This is called enteral nutrition. The benefit of this is that it avoids the side effects of medication – which is especially relevant for children. A recent Chinese meta-analysis of data even reports that exclusive enteral nutrition was equally effective as corticosteroid medication when given to children with Crohn’s disease [5, 6].

But what exactly is enteral nutrition and how does it work?

Over a period of 6-8 weeks, enteral nutrition provides the complete daily nutritional requirements through liquid formulations delivered orally or through nasogastric or gastrostomy tubes [7]. Beforehand, malnutrition and individual caloric needs need to be identified by a dietician. The treatment influences the bacterial milieu, shifting away from a pro-inflammatory state. It is established as the primary therapy in children, while it is less used in adults due to patients’ preference and availability of other therapeutic options such as biologics. Overall, enteral nutrition should be discussed with patients and offered especially if they desire a non-pharmacological therapy [8].